How To Find a Midwife, For Home Birth Moms

Pregnant women who want to arrange a home birth often wonder how to find a midwife to help them with the entire labor and delivery process. Now that the American Academy of Pediatrics (AAP) has issued its first guidelines for how to safely prepare and care for newborns born at home, the question about midwives becomes especially important.

What pregnant women should know about midwives

A midwife is an individual who has been trained to provide care and support of pregnant women mainly during labor and delivery, but also during pregnancy and post delivery. Such care and support can include performing gynecological examinations, helping with prenatal care, guiding new mothers with breastfeeding and newborn tasks, in addition to assisting with labor and the birth itself.

Not all midwives have the same amount or type of training, and each state has different regulations regarding certification of midwives. Therefore, it’s important for pregnant women and their partners to inquire about the requirements in their state. Here are the four different types of midwives.

Certified nurse midwives (CNMs). These individuals are trained as both nurses and midwives and have at least a bachelor’s degree. Before CNMs can practice, they must pass a national certification examination from the American College of Nurse-Midwives (ACNM) and be granted a state license.

Certified midwives (CMs) have a college education and are certified by the ACNM. Only some states license certified midwives.

Certified professional midwives (CPMs) are certified by another organization--the North American Registry of Midwives (NARM)—and not all states certify CPMs.

Direct-entry midwives (DEMs) are the lowest level of midwife in the category. DEMs may or may not have a college degree. Some receive their training via apprenticeship, self-study, instructional programs, or workshops. Midwives in this group typically attend births in homes or birthing centers. Not all states recognize DEMs.

Among the new guidelines issued by the AAP, there are provisions related to midwives, stating that women who have a planned home birth should be attended only by midwives who have been certified by the American Midwifery Certification Board. Women should be sure the midwife they choose fits this requirement.

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Women also should question any prospective midwife about her position concerning the use of pain medication, induced labor, cesarean sections, and other medical interventions. It is important for pregnant women and their midwife to agree on the course of action regarding these issues.

In addition to recommendations regarding the use of midwives, the AAP guidelines also address a long list of other factors, including but not limited to the following. Women can discuss these issues with their midwife candidate as well.

Having a preexisting plan for safe and rapid transportation of the mother and child to a local hospital in case of emergency

Having at least one person at delivery whose main responsibility is the welfare of the mother and another individual whose main responsibility is the newborn

Having at least one of the people in attendance skilled in providing full resuscitation if necessary, and having the equipment needed to perform it

Providing transitional care (during the first 4-8 hours after birth) during which the newborn should be kept warm, have a detailed physical examination, and be monitored for activity, which should be recorded at least every 30 minutes until the child’s condition is deemed normal

Administering prophylaxis against gonococcal ophthalmia neonatorum

Providing universal newborn screening, in accordance with individual state mandates, within 24 to 48 hours of birth

Women who want to prepare for a planned home birth need to do their homework to ensure they and their newborns have a safe pregnancy, labor, and delivery. Use of a midwife is one critical part of that planning.

SOURCES:
American Academy of Pediatrics. Planned home birth. Committee on fetus and newborn.Pediatrics 2013 April 29 published online
American College of Nurse-Midwives